Bernie Sanders became the first 2020 presidential candidate to come out in support of finding a global cure for AIDS. Scientists and researchers have been working toward a cure, but they insist that full support and additional resources from the government is necessary to find the solution. With his announcement, Sanders told the Research Foundation to Cure AIDS that “the U.S. can lead the world in finding the global cure for AIDS,” Block Toro reported.

Since Sanders’ announcement, almost every other presidential hopeful followed suit, supporting a cure for HIV/AIDS.

“We have all of the technology needed to end AIDS-related deaths and stop HIV transmission and develop a working cure for AIDS,” Sanders said. “All we need now is the political will to do it.”

In a series of questions asked by the Research Foundation to Cure AIDS (RFTCA), Sanders said that as president he would form a team of the top U.S. scientists, researchers and doctors to find a cure for HIV/AIDS, make sure every citizen had access to affordable treatment, work with the international community to help find a cure, as well as provide affordable medicine and hold Big Pharma accountable.

Sanders’ leadership and support of the cause won him praise by Kambiz Shekdar, Ph.D., RFTCA president.

“The cure for HIV/AIDS has been proven possible but the main struggle is to raise the funds needed to make it happen in real life,” Shekdar said. “We would need a presidential leadership like Bernie’s for developing the cure for all the patients in need.”

According to a transcript, Sanders “introduced curing AIDS as a new pillar” to his comprehensive AIDS address.

“Bernie believes that we can and we must end the AIDS epidemic in the United States and abroad, and we can lead the world by developing a cure for AIDS. Bernie will invest significant federal resources and convene experts, advocates, scientists, and researchers to ensure this goal is met. The United States has before come together to achieve things once thought impossible. What we need is a grassroots political movement that will stand up to the greed of the pharmaceutical industry and take the steps necessary to ensure we end the AIDS epidemic by 2025 and ensure no person in America dies because they cannot afford medication or health care. Bernie is proud to say he will, alongside a political movement, rise to this challenge.”

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An assessment of sexual risk behaviors, as they relate to viral suppression, from before, during and after incarceration among persons living with HIV and alcohol use or opioid use disorders demonstrated that the risk of HIV transmission among this population is low.

“After release to the community, criminal justice involved persons with HIV and co-occurring substance use disorders (SUDs ) reduce sexual risk behaviors (SRBs),” Sandra Springer, MD, associate professor of medicine and associate clinical professor of nursing at Yale School of Medicine and director of the Infectious Disease Outpatient Clinic at the VA Healthcare Services in Newington, Connecticut, told Infectious Disease News. “They also have improved viral suppression when treated with extended-release naltrexone and antiretroviral treatment.”

The results for this study were secondary outcomes from two previous randomized double-blind, placebo-controlled trials — funded by the NIH — which investigated “the impact of extended-release naltrexone (an FDA-approved medication for opioid and alcohol use disorders) among persons living with HIV and opioid and alcohol use disorders, respectively, who were incarcerated in prison or jail,” according to Springer.

The researchers noted that there are limited studies evaluating the SRBs and viral suppression as they relate to SRBs among persons with HIV upon release from the criminal justice system, despite a three times greater prevalence for HIV among those in the system compared with that of the general population.

Data collected 30 days before incarceration demonstrated that 60% of participants reported having sex. Comparatively, at 1 month after release, 41% reported having sex and, at 6 months after release, that percentage increased to 46%.

The researchers observed a decrease in the reported number of sex partners and sexual intercourse events from preincarceration to 1 month and 6 months after release. Although not statistically significant, use of condoms increased. At 1 month after release, 9.7% of individuals reported not using a condom during sex. The researchers reported that “only” two were not virally suppressed. At 6 months, 6.5% reported having sex without a condom, but all were virally suppressed.

“Among this group, we were unable to determine exactly why sexual risk behaviors decreased,” Springer said. “We posit that it may be due to several factors, including reductions in alcohol or drug use, relationships ended when participants entered the [criminal justice system (CJS)] and no new sexual partners were found post-release, or relationships continued after release and offered stability.”

According to the study, SRBs declined following release from jail or prison among persons living with HIV and alcohol use or opioid use disorders. Furthermore, viral suppression rates were high among those who did report SRBs.

“This study shows that when people are started and maintained on treatment for opioid and alcohol use disorders combined their medications for HIV, HIV viral suppression is improved and thus the risk of HIV transmission is reduced,” Springer said. “It also shows that there is a public health benefit to screening and initiating SUD treatment prior to release from the CJS, as well as linking people to HIV care after release.” – by Marley Ghizzone

Disclosures: Springer reports receiving grant support from the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse, and donated medication from Alkermes Inc, which was donated to this National Institutes of Health-funded research. Springer also reports providing consultation to Alkermes Inc. regarding published literature of extended release naltrexone outcomes.

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Let’s talk about drugs—specifically, drugs that keep HIV-positive gay men like me “undetectable,” and the drugs used in PrEP (pre-exposure prophylaxis) that, when taken daily, can prevent HIV-negative gay men (and others) from becoming infected.

That’s essentially the theme for this year’s  Gay men’s HIV/AIDS Awareness day —today, September 27—“The Conversation About HIV Is Changing: Talk Undetectable. Talk PrEP.”

But if we only talk about drugs to prevent and treat HIV, and don’t talk about the trauma behind gay men’s high-risk sexual and drug-use choices, we’ll see that same trauma continue to play out in our disproportionately high rates of crystal meth abuse, alcoholism, and other potentially harmful sexually transmitted infections besides HIV.

There is no question that today’s HIV drugs have dramatically changed the conversation about HIV. From the terrible illness and death that almost inevitably followed a positive HIV test 30 years ago, those of us living with the virus today can expect to live a virtually normal lifespan —so long as we adhere to treatment.

There’s a movement with the slogan “U = U” to emphasize the momentous shift in thinking about what it “means” to have HIV because of studies demonstrating that those of us living with HIV who keep our virus suppressed cannot infect someone else.

Knowing we don’t put our partners at risk is a huge relief. Educating those who don’t have HIV to understand this fact should help ease the stigma that too many still attach to HIV. If there’s nothing to be afraid of from an HIV-positive person, there likewise should be no reason to rule out sex play or a relationship with that person—or to treat him like a pariah.

Steve Gibson, the founder in 2003 of San Francisco’s gay men’s sexual health clinic Magnet—in 2016, it was blended into Strut, on Castro Street, the city’s one-stop-shop for gay men’s health and well-being—told me in an interview for my book Stonewall Strong that PrEP is transforming how gay men relate to one another across what has often been called the HIV “viral divide.”

“What we’re seeing in San Francisco now,” said Gibson, “is very good public health attempts to encourage disclosure around serostatus. For the first time in my 25 years in public health, the conversation is changing around how positive and negative gay men are talking to each other about terms like ‘clean’ and ‘dirty’ and the stigma we internalized as a community. We know that viral suppression is highly effective and that PrEP is highly effective. So we can have a conversation about our desires.”

That’s a part of the conversation we really need to have if we are serious about supporting gay men’s health. As important as the HIV drugs are, this conversation has to be about more than providing drugs to prevent or treat HIV. In fact it goes well beyond HIV.

We need a conversation about the extraordinary traumas of gay men’s lives beginning when we first become aware of being “different.” We need to talk about the damaged self esteem that leads so many of us to engage in risky sex or medicate our lonoliness and psychic pain with alcohol and other substances.

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